Thyroid

Question 1

Mx of hypothyroidism

DDx
- Autoimmune (Hashi)
- Iatrogenic (RT/thyroidectomy)
- Iodine deficiency

Answer 1

• targeted HEI - goiter/tire/TSH/T4/abs
• M risk -Abruption/PIH/PET/PPH
• F risk - MC/IUGR/PTB/SB
• N risk - neo hypothyroid if abs
• MDI - Obs/Med/Paed
• Endo referral - OH need Thyroxine
• TFTs each trimester
• Serial G/S
• Timing/MOD - Obs indication
• IP - active 3rd stage (PPH risk)
• PN - Paeds - cord blood TFT - observe, maternal F/U - if anti-TPO - risk of postpartum thyroiditis

Question 2

Mx of hyperthyroidism

DDx
- grave’s (TSH ab)
- thyroiditis (subacute, viral)
- medication (lithium…)
- multi-nodular goiter

Answer 2

• HEI - heat intol/palp/goitre/TSH/T4/abs
• M risk - SVT/AF/Anesthetic if goitre
• F risk - MC/IUGR/PTB/Fetal thyrotox
• N risk - neo grave’s/hypothyroid
• MDI - Obs/Med/Paed
• Endo referral - PTU+/- propranolol
  (med > surg > RT (CI in preg)
• TFT each trimester
• Serial G/S
• Timing/MOD - Obs indication
• IP - nil specific
• PN - Paeds - cord blood TFT + observe, maternal F/U & completion of Rx…